Spit Up: Is it Normal that my Baby Keeps Spitting Up? 

Ask the Dietitian - Spit Up: How do you know what's normal and when should you be concerned?

Feeding time can sometimes be confusing and challenging for new parents, especially when it comes to navigating spit up.Parents may wonder what’s normal and what’s not when their newborn keeps spitting up. If your newborn is spitting up a lot and you’re not sure if it is excessive spit up or if your baby is a normal or “happy spitter,” then read on to find out the Nature’s One dietitian’s answers to your top questions about spit up.

What is spit up?

Spit up is defined as spitting up, with no effort or crying, small amounts (1 or 2 mouthfuls) of breastmilk or formula at a time. It is considered a normal symptom that occurs in many babies.¹

Why do babies spit up?

As we watch newborn babies grow and develop on the outside, we know they are growing and developing on the inside too! Part of the development that happens includes the maturation of a baby’s gastrointestinal tract. A special muscle between a baby’s esophagus and the stomach (called the lower esophageal sphincter) should keep the contents of the stomach in place. However, if this muscle is immature – or if there is too much pressure on the muscle due to certain positions or an overfilled stomach – then the muscle can be involuntarily relaxed, causing stomach contents to re-enter the esophagus leading to spit-up. When you see your baby spit up formula, what you see are those stomach contents coming back up through their esophagus and mouth.

When is spit up considered normal?

Infant spit up can be considered normal when it first becomes present early on in life, when it is present for several days or weeks, and when there is no pain, crying, or effort associated with spit-up. If your baby looks well, acts happy, and is growing appropriately, they may be considered a normal, happy spitter.¹

Again, some babies are “happy spitters” and have no medical problems. This is often just a natural occurrence with some babies, but can be very alarming for parents to see their child spit up what seems like the whole feeding, when in fact, it is simply a small amount of stomach contents. It’s important to remember that a baby's stomach is small, and because it is small, it can only tolerate small amounts of feedings. A large feeding would increase the pressure within the stomach and could facilitate more spitting up.

What is the difference between reflux, spit up, and gastroesophageal reflux disease?

The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) defines gastroesophageal reflux (GER) as the passage of gastric contents into the esophagus with or without regurgitation and vomiting.

When contents from the stomach pass into the mouth, this is known as regurgitation or spitting-up.

When GER leads to troublesome symptoms that affect daily functioning (like excessive irritability, failure to thrive, feeding refusal, wheezing, cough) and/or complications (like anemia, esophagitis, asthma, recurrent pneumonia, recurrent ear infections), this is then known as gastroesophageal reflux disease (GERD).²

What is the difference between spit up and vomit?

Generally, spit up occurs with no effort or discomfort involved while vomiting is often forceful and the baby becomes uncomfortable. When vomiting shoots out of the baby’s mouth, this is called projectile vomiting. When a newborn is vomiting, they should be seen by their healthcare provider as this could indicate illness or a condition known as pyloric stenosis.

What can help a baby with spit up?

If a baby is a natural spitter (or “happy spitter”), then the following Care Suggestions may help to reduce spit up:

• During feedings and for at least 30 minutes after feedings, keep the infant in an upright position.While breast or bottle feeding, hold the baby in an inclined position to keep the baby’s head higher than the stomach.
• Unless the baby is less than 1 month of age or is not gaining weight well, try feeding smaller amounts per feeding (like 1 ounce fewer than usual) or going a longer time between feedings (like every 2 to 3 hours when the baby is awake). The reason for this is that overfeeding can increase stomach pressure and lead to spitting up.
• Burp the baby a few times during the feeding rather than waiting until the end of the feeding.
• Keep the baby in loose clothing and loose diapers. Avoid tight clothing around the waist.
• Spend less time with a pacifier and ensure a bottle’s nipple size isn’t too small. Both pacifiers and smaller-than-appropriate nipple holes on a baby’s bottle can mean that a baby swallows extra air, which can increase stomach pressure and spit-up.

You may also be interested in these tips from the American Academy of Pediatrics on Why Babies Spit Up.

What is the best formula for spit up?

No matter what formula a baby is fed, considering the Care Suggestions above are important when a baby spits up. For babies who are “happy spitters” with no other symptoms and who are growing appropriately, it may not be necessary to change formulas if the Care Suggestions help improve the spit up.³ Talk to your child’s healthcare provider.

The first steps for an infant suspected to have GERD are to avoid overfeeding, to consider thickening feeds, and, if breastfed, to continue breastfeeding.² If you are considering thickeningyour child’s formula or breastmilk, be sure to talk with your child’s healthcare provider about if you should and how you can do this.

If after completing these steps the baby’s symptoms do not improve, then a protein hydrolysate or an amino acid-based formula is recommended or, for breastfed infants, moms are recommended to eliminate cow’s milk in their diets.²

Although extensively hydrolyzed and amino acid-based formulas may be recommended for babies with GERD, Nature’s One does not offer these types of formulas since they presently do not meet USDA Organic standards. However, if a child’s healthcare provider recommends the removal of cow’s milk from the child’s diet, then Baby’s Only® Organic Plant Based Pea Protein Toddler Formula may be an option to discuss. Or, if reflux is related to a lactose intolerance or sensitivity, then Baby's Only® Organic Sensitive DHA/ARA Toddler Formula may be considered since through special organic compliant enzyme process, the lactose within this formula is removed.

What should I do if my baby has excessive spit up?

Monitoring your baby’s growth and weight patterns can help ease concerns about whether your baby’s spit ups are affecting overall nutritional health. If you believe the spit ups are excessive or are getting worse, contact your baby’s healthcare provider.

If your baby is vomiting, has poor weight gain, or if your child’s spit up becomes worse even when engaging in spit up reduction techniques, see your child’s healthcare provider.

When should my baby’s spit up improve?

As an infant gets older, reflux often improves after the baby learns to sit well (like by around 7 months of age).¹ In one study, just over 1 in 10 babies experienced GER (gastroesophageal reflux, ‘spit up’) at 12 months of age, compared to nearly 6 in 10 babies experiencing the same at 3 months of age, when spit up symptoms peak in babies with GERD.⁴

Monitoring your baby’s growth and weight patterns can help ease concerns about whether your baby’s spit ups are affecting overall nutritional health. If you believe the spit ups are excessive, check with your baby’s healthcare provider to be sure nothing medically is going on.

What other questions do you have about spit up? Contact the Nature’s One dietitian at dietitian@naturesone.com.

**For specific medical care and nutritional advice on product usage, please see your healthcare professional

References:

1. Schmitt B. Spitting Up – Reflux. Schmitt Pediatric Guidelines LLC. Healthychildren.org. Accessed January 3 2022 from https://www.healthychildren.org/English/tips-tools/symptom-checker/Pages/symptomviewer.aspx?symptom=Spitting+Up+-+Reflux
2. Rosen R, Vandenplas Y, Singendonk M, Cabana M, DiLorenzo C, Gottrand F, Gupta S, Langendam M, Staiano A, Thapar N, Tipnis N, Tabbers M. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2018 Mar;66(3):516-554. doi: 10.1097/MPG.0000000000001889. PMID: 29470322; PMCID: PMC5958910.
3. Czinn SJ, Blanchard S. Gastroesophageal reflux disease in neonates and infants : when and how to treat. Paediatr Drugs. 2013;15(1):19-27. doi:10.1007/s40272-012-0004-2
4. Curien-Chotard M, Jantchou P. Natural history of gastroesophageal reflux in infancy: new data from a prospective cohort. BMC Pediatr. 2020;20(1):152. Published 2020 Apr 7. doi:10.1186/s12887-020-02047-3